Shoulder Blade Pain: Causes and Treatment Options

Please inquire about scapula issues?

Dear Dr.
Su,
I have been experiencing pain in the lower left side of my neck and upper back since mid-August of this year.
After consulting a doctor, I was advised to apply heat and was prescribed oral medication, but the doctor did not specify what the condition was.
I suspect it might be something like myofascial pain syndrome or periostitis.
At that time, in addition to the back pain, I also had intermittent sharp pain in my left clavicle (from the center to the end), but since the back pain was much more severe, I forgot to mention it to the doctor.
Now, while the back pain has subsided, the unexplained sharp pain in my clavicle persists (it comes intermittently every two to three days, lasting about ten minutes each time), and there are no other unusual symptoms.
My younger brother once had a bacterial infection in his foot bones, which was fortunately discovered early; otherwise, he might have faced amputation.
Therefore, I would like to ask if you think I might have a similar issue, or if there could be other possibilities? Or could this just be part of the growth process, and I shouldn't worry too much? Thank you for taking the time to respond.

Cathy, 20~29 year old female. Ask Date: 2004/09/15

Dr. Su Yiren reply Orthopedics

Hello Cathy,
1.
If there is persistent pain in specific areas of the body, it should be thoroughly examined.
The most basic step is to perform an X-ray to check for any acromioclavicular joint pathology or cervical spine nerve compression.
There have been cases where individuals with shoulder pain were found to have lymphadenopathy during hospital examinations, and subsequent biopsy revealed metastatic breast cancer.
2.
Due to the feet being farther from the heart, injuries and infections in this area can easily lead to ischemic necrosis due to poor circulation, potentially resulting in amputation.
In my years of medical practice, I have encountered at least three cases where individuals suffered toe amputations due to foot injuries from car accidents.
Fortunately, most conditions do not progress to such severity because of early intervention.
However, in cases where the infection invades the bone marrow, it can lead to osteomyelitis, which is serious and requires aggressive treatment.
Otherwise, it can progress to "chronic osteomyelitis," occurring every three to five months, and even lead to ulceration forming a sinus tract that requires daily dressing changes.
If it develops into a "non-healing foot," it becomes a significant issue!

Reply Date: 2004/09/15

More Info

Shoulder blade pain can arise from various causes, and understanding these can help in determining the appropriate treatment options. Based on your description, it seems you have been experiencing pain in the left shoulder area, particularly around the clavicle, which has persisted even after treatment for your back pain.

Possible Causes of Shoulder Blade Pain
1. Muscle Strain or Overuse: One of the most common causes of shoulder pain is muscle strain, often resulting from overuse or poor posture, especially in individuals who spend long hours at a desk or in front of a computer. This can lead to conditions like myofascial pain syndrome, where trigger points in the muscles cause referred pain.

2. Rotator Cuff Injuries: The rotator cuff is a group of muscles and tendons that stabilize the shoulder. Injuries or tears in these structures can lead to pain and limited range of motion. Symptoms may include pain when lifting the arm or sleeping on the affected side.

3. Bursitis: Inflammation of the bursa (a small fluid-filled sac that reduces friction between tissues) can cause pain in the shoulder area. This is often associated with repetitive overhead activities.

4. Cervical Radiculopathy: Nerve compression in the cervical spine can lead to pain radiating to the shoulder and arm. This can occur due to herniated discs or degenerative changes in the spine.

5. Acromioclavicular Joint Issues: Problems with the acromioclavicular joint, such as arthritis or injury, can cause pain in the shoulder area, especially during overhead activities.

6. Referred Pain: Sometimes, pain in the shoulder can be referred from other areas, such as the heart or lungs, particularly if there are underlying conditions.

Treatment Options
1. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the shoulder and improve flexibility. A physical therapist can provide exercises tailored to your specific condition.

2. Medications: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen or naproxen), can help reduce pain and inflammation. If the pain is severe, your doctor may prescribe stronger medications.

3. Heat and Cold Therapy: Applying heat can help relax and loosen tissues and stimulate blood flow to the area, while cold therapy can reduce inflammation and numb sharp pain.

4. Corticosteroid Injections: If conservative treatments do not provide relief, corticosteroid injections into the shoulder joint or bursa can reduce inflammation and pain.

5. Surgery: In cases where there is a significant injury, such as a complete rotator cuff tear or severe arthritis, surgical intervention may be necessary. However, this is typically considered a last resort after other treatments have failed.

6. Lifestyle Modifications: Improving posture, taking regular breaks during prolonged activities, and avoiding heavy lifting can help prevent further strain on the shoulder.

Monitoring Symptoms
Given your family history of bacterial infections and your ongoing symptoms, it is essential to monitor your condition closely. If you experience any of the following, you should seek medical attention promptly:
- Increasing pain or swelling
- Fever or chills
- Numbness or weakness in the arm
- Changes in skin color or temperature around the shoulder

Conclusion
While your symptoms may be related to muscle strain or overuse, it is crucial to rule out more serious conditions. If your pain persists or worsens, consider following up with a healthcare provider for a thorough evaluation, which may include imaging studies like X-rays or MRI to assess the underlying structures of your shoulder and neck. Early intervention can lead to better outcomes and prevent chronic issues.

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